Evaluation of endocrine function in children admitted to pediatric intensive care unit

Aydın, Banu Küçükemre; Demirkol, Demet; Baş, Firdevs; Türkoğlu, Ümit; Kumral, Alkın; Karaböcüoğlu, Meti̇n; Çıtak, Agop; Darendelıler, Feyza

doi:10.1111/ped.12269

Cited by 9 publications

(13 citation statements)

References 37 publications

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“…This could be related to the complex and bidirectional cortisol changes that take place during septic illness, whereby both high and low cortisol levels have been associated with increased illness severity and poor physical outcomes [6–9] but also possibly to the use of corticosteroid medication in the septic group, as there is some evidence of links between use of corticosteroids for septic shock and critical illness and PTSD symptoms [1, 38, 39]. …”

Section: Discussionmentioning

confidence: 99%

“…High cortisol levels have been reported during critical illness in both adults and children, although there is considerable individual variation [4–6]. In children with septic shock and meningococcal disease, both high and low cortisol levels have been associated with increased illness severity and poor physical outcomes [6–9]. Inadequate cortisol levels in the face of severe physiological stress and associations between cortisol and illness severity have also been reported in other critical illnesses [9, 10].…”

Section: Introductionmentioning

confidence: 99%

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Stress hormones and posttraumatic stress symptoms following paediatric critical illness: an exploratory study

Als

Picouto

O’Donnell

et al. 2016

Eur Child Adolesc Psychiatry

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In this exploratory case–control study, we investigated basal cortisol regulation in 5–16-year-old children, 3–6 months following PICU (paediatric intensive care) admission. This was nested within a study of child psychological and cognitive function; 47 children were assessed alongside 56 healthy controls. Saliva samples were collected three times per day (immediately after waking, waking +30 min, and waking +12 h) over two consecutive weekdays. In addition, data on posttraumatic stress symptoms were ascertained from 33 PICU admitted children using the Impact of Events Scale-8 (IES-8). Primary analysis revealed no significant differences in basal cortisol concentrations between PICU discharged children and healthy controls (p > 0.05). Secondary analysis in the PICU group identified a significant positive association between posttraumatic stress symptoms and evening (waking +12 h) cortisol concentrations (p = 0.004). However, when subject to multivariate analysis, evening cortisol was a modest independent predictor of IES-8 scores, relative to the presence of septic illness and poor pre-morbid health. We conclude that paediatric critical illness does not appear to result in marked perturbations to basal cortisol at 3–6 month following discharge. There was evidence of a link between evening cortisol and symptoms of PTSD, but this was not a robust effect and requires further elucidation.Electronic supplementary materialThe online version of this article (doi:10.1007/s00787-016-0933-3) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Stress hormones and posttraumatic stress symptoms following paediatric critical illness: an exploratory study

Als

Picouto

O’Donnell

et al. 2016

Eur Child Adolesc Psychiatry

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“…Although HPA axis alterations have been described in children suffering from meningococcal sepsis [10][11][12], the dynamics, drivers and prognostic value of systemic cortisol availability in the broader population of critically ill children have only scarcely been investigated [13,14]. Nevertheless, studies have suggested that a substantial proportion of critically ill children may not be able to increase systemic cortisol availability enough to face the stress of the critical illness, which could cause hemodynamic instability and systemic hyperinflammation with need for vasopressor support [15,16].…”

Section: Introductionmentioning

confidence: 99%

Dynamics and prognostic value of the hypothalamus–pituitary–adrenal axis responses to pediatric critical illness and association with corticosteroid treatment: a prospective observational study

et al. 2019

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Purpose: Increased systemic cortisol availability during adult critical illness is determined by reduced binding-proteins and suppressed breakdown rather than elevated ACTH. Dynamics, drivers and prognostic value of hypercortisolism during pediatric critical illness remain scarcely investigated. Methods: This preplanned secondary analysis of the PEPaNIC-RCT (N = 1440), after excluding 420 children treated with corticosteroids before PICU-admission, documented (a) plasma ACTH, (free)cortisol and cortisol-metabolism at PICU-admission, day-3 and last PICU-day, their prognostic value, and impact of withholding early parenteral nutrition (PN), (b) the association between corticosteroid-treatment and these hormones, and (c) the association between corticosteroid-treatment and outcome. Results: ACTH was normal upon PICU-admission and low thereafter (p ≤ 0.0004). Total and free cortisol were only elevated upon PICU-admission (p ≤ 0.0003) and thereafter became normal despite low binding-proteins (p < 0.0001) and persistently suppressed cortisol-metabolism (p ≤ 0.03). Withholding early-PN did not affect this phenotype. On PICU-day-3, high free cortisol and low ACTH independently predicted worse outcome (p ≤ 0.003). Also, corticosteroidtreatment initiated in PICU, which further suppressed ACTH (p < 0.0001), was independently associated with poor outcomes (earlier live PICU-discharge: p < 0.0001, 90-day mortality: p = 0.02). Conclusion: In critically ill children, systemic cortisol availability is elevated only transiently, much lower than in adults, and not driven by elevated ACTH. Further ACTH lowering by corticosteroid-treatment indicates active feedback inhibition at pituitary level. Beyond PICU-admission-day, low ACTH and high cortisol, and corticosteroid-treatment, predicted poor outcome. This suggests that exogenously increasing cortisol availability during acute critical

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“…In pediatric populations, altered cortisol response constitutes a special challenge to the managing teams. However, this issue was rarely investigated in comparison to the frequently published studies on adult patients 9 .…”

Section: Introductionmentioning

confidence: 99%

Relation between Baseline Total Serum Cortisol Level and Outcome in Pediatric Intensive Care Unit

Bekhit

Mohamed

Yousef

et al. 2019

Sci Rep

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Elevated cortisol level is an component of the stress response. However, some patients have low cortisol levels; a condition termed: critical illness-related corticosteroid insufficiency (CIRCI). Basal cortisol levels during PICU admission may be related to outcome. This prospective cohort study aimed to assess basal total serum cortisol levels and their relation to outcome in PICU. The study included 81 children over 6 months. Total serum cortisol was assessed using an early morning sample. The severity of illness was assessed using the PRISM-III score. Outcome measures included mechanical ventilation duration, use of inotropic support, length of stay, mortality. Comparison between patients’ subgroups according to total serum cortisol levels revealed significantly higher PRISM-III score in patients with total serum cortisol levels. In addition, those patients had a significantly higher mortality rate when compared with patients with low and normal total serum cortisol levels. Multivariate logistic regression analysis recognized high total serum cortisol level and PRISM-III score as significant predictors of mortality. We concluded that PRISM-III score and elevated total serum cortisol levels are significant predictors of mortality in the PICU. Although CIRCI is prevalent in this population, it wasn’t associated with an increased mortality rate.

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Evaluation of endocrine function in children admitted to pediatric intensive care unit

Cited by 9 publications

References 37 publications

Stress hormones and posttraumatic stress symptoms following paediatric critical illness: an exploratory study

Stress hormones and posttraumatic stress symptoms following paediatric critical illness: an exploratory study

Dynamics and prognostic value of the hypothalamus–pituitary–adrenal axis responses to pediatric critical illness and association with corticosteroid treatment: a prospective observational study

Relation between Baseline Total Serum Cortisol Level and Outcome in Pediatric Intensive Care Unit

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